Communication issues in the office are sometimes a joke. Sometimes a  challenge.

Jocelyn, our animated, black, female Physicians Assistant, is fun to torment - but she has a retaliatory streak.

 She is about to suture some guy’s finger. She has been consulting with Kanvar - one of the young-buck, junior doctors in the office. I ask her if she “wants the senior physician to supervise her?”

She asks me, in supposed innocence, “do I want the senile physician to supervise me”?

Then John, with his diverticulitis, tells me he has multiple, huge, bowel movements everyday. And his wife tells him she’s “never known anyone so full of shit”.

And I tell him “she’s not talking about your bowel movements”.

This is the lighter side of the serious issue of communication.

Gwen tells me she is “fuzzy”. So I expect her to have some arcane dermatological condition or weird form of hirsutism.

Then she tells me she has to lie on the floor and hold on. I fancy she is “dizzy” not “fuzzy”. More likely an inner ear problem than that she really has an integument like a peach - or those dice you hang on the rear view mirror (that The Car Guys are so obsessed with).

Not out of malice, not intentionally, but the poor historian can mislead you. They will tell you their conclusions not their symptoms. They will use the wrong words.

There are many Mrs. Malaprops, telling us of their “abominable” pain that they think is their appendix. Or “fireballs” in the uterus giving them heavy periods. Or a Mr. Malaprop who went to the urologist claiming he has a “prostrate” problem (more likely after the exam).

It is not the exclusive domain of the patient incidentally. Dr Wonton, on the groups Board of Directors gets all wound up in long belligerent diatribes at meetings, and not infrequently puts his foot in his mouth. Like when he told us he “didn’t like the promiscuous note” the bank was insisting all the shareholders needed to sign to guarantee the loan we were applying for.

OK, this is all very facile. But, as I have said before, communication is a serious issue. To head off the circumlocutory, or misleading patient, and get the information one needs, one has to snap into interrogatory mode.

And then everyone bitches about how “doctors don’t listen, they just jump in with questions”.

So I need to tell Gwen to be more precise - or maybe she really is fuzzy?

     Dizzy or fuzzy?

 There are quite a lot of my female patients I find myself lusting after. And it’s not just the young, hotties, who I would expect to be attracted to. I have always noticed that I am particularly turned on by the vulnerable patient.                                                                   

Now I find there is a reason for, or at least recognition of, this phenomenon - ironically named after one of the heroines of medical history who is the antithesis of sexuality.

The idea of a doctor being sexually attracted to his patients may be disturbing. But there are strict regulations to constrain doctors, and other therapists, from getting their hands (or other appendages) on their patients - which is surely testimony to the fact that doctors do lust after their patients.

Inevitably in a general practice one will have attractive female patients - and, at the risk of sounding obscenely lecherous, doing “well woman” exams on some teenager as a requirement (payment?) for prescribing her the pill, or volunteering to do sports physicals on the cheerleaders and others at the local high school, are the perks of the job (except that I always seemed to get allocated to the boys line, and finished up palpating a lot of hernial orifices and being coughed on).

This is all frightfully taboo and non-PC I know, but is a reality. Surfing the web, on such sights as ‘Yahoo Answers’, there seems to be a lot of intrigue, and people asking, “is the doctor really lusting over me?”

I guess it is perfectly natural to have a sexual attraction to young nubile females. But what’s always intrigued me is the enhanced sexual attraction I find for women who are vulnerable. Particularly women who are depressed. Maybe it’s just that depression is the most overt manifestation of this vulnerability?

It puts me in mind of the drop-dead gorgeous ICU nurse who I was treating for depression, and over whom I would salivate (in a very discreet way of course). She told me about her heartbreaking conviction that she felt she could never have a good, intimate relationship with a man.

Boy, was tempted to offer!  - Just worried about what the wife would say.

Then there is the young woman (ex-cheerleader), who is not depressed but has chronic pelvic pain and is on a boatload of narcotics - who can always manipulate me into re-prescribing early when she runs out too soon by playing on my less honorable desires.

The feelings are an inevitability it seems to me. What matters of course is if the doctor is not the tight laced, constrained professional he is meant to be and acts on these lusts.

Being a doctor, or other kind of therapist (on kspope.com website I found a claim that 95% of male psychotherapists have been sexually attracted to their clients) one is in a position of undue influence, and I guess one has to respect, and not abuse, that - even if one is a horny old bastard.

I am posting about this now because when I was reading about the Crimean War, and the birth of the nursing profession for a ‘Medical Yarns’ project I’m working on, I came across an explaination, or recognition of this phenomenon - however unlikely that may sound.

I came across the Florence Nightingale Syndrome.

Now our dear Florence was a bit of a cold fish - or strange fish at least in the relationship department -  it would seem. She was the epitome of the straight laced, Victorian gentlewoman (probably why Queen victoria liked her so much), and not exactly a sex object.

She refused to marry because it would get in the way of her work. Mostly didn’t like women and often refered to herself in the masculine, and pretty much took to her bed when she came back from Crimea - some say, just to get away from people.

It is a common misinterpretation that this syndrome is the patient being attracted to the doctor/therapist. That is not the true definition of it, and  I would call that the “Doctor Kildare Syndrome” or something.

If we are to believe Wikipedia,  what ‘The Florence Nightingale Syndrome’ really is, is “a situation where a caregiver, typically a doctor or nurse, develops an emotional attachment to a vulnerable patient in his or her care. This attachment may progress into a sexual attraction”.

See, I might be a dirty old man - but it’s just natural.